TO: Honorable Mayor & Members of the North Port Commission
FROM: A. Jerome Fletcher II, ICMA-CM, MPA, City Manager
TITLE: Approve the Updating of the Online Portal and Completion of the Medicare Enrollment Application and Associated Agreements to Reflect Mayor Stokes as the Assigned Authorized Official to Allow for North Port Fire Rescue’s Primary Billing Company, Digitech, to Submit Claims and Receive Remits on North Port Fire Rescue’s Behalf.
Recommended Action
Approve the updating of the online portal and completion of the Medicare Enrollment Application and Associated Agreements to reflect Mayor Stokes as the Assigned Authorized Official to allow for North Port Fire Rescue’s primary billing company, Digitech, to submit claims and receive remits on North Port Fire Rescue’s behalf.
Background Information
The following Agreements will allow North Port Fire Rescue's primary billing company, Digitech, to submit claims directly to Medicare. The online portal and applications/agreements must be created and updated as new Authorized Officials (AO) are assigned. Mayor Stokes has been identified as the AO for these documents, per Legal’s guidance. These were previously completed by former Mayor Luke, Mayor Emrich and Mayor Langdon.
Ø Medicare Enrollment Application: CMS-855B will require Section 6: Ownership Interest and/or Managing Control Information (Individuals) be completed by Mayor Stokes in order for Digitech to populate the remainder of the application via an online portal to subsequentially be digitally signed. Also required is Section 15: Certification Statement which will certify the application to update Mayor Stokes as the new Authorized Official.
Ø Medicare Electronic Data Exchange (EDI) Enrollment and Medicare EDI SPOT Enrollment Form: Relates to electronic medical claims and receiving electronic payments from Medicare for said claims. These forms grant Digitech online access to our Medicare claims to submit the claims on our behalf.
The updating of the online portal and completion of the Medicare Enrollment Application and Associated Agreements to reflect Mayor Stokes as the Assigned Authorized Official to allow for North Port Fire Rescue’s primary billing company, Digitech, to submit claims and receive remits on North Port Fire Rescue’s behalf has been reviewed by the Interim City Attorney and is legally correct as to form.
Strategic Plan
Maintain the adopted level of health and public safety services.
Financial Impact
While there is no cost associated with updating the associated Agreements, failure to submit these Agreements would result in the suspension of our provider number, resulting in a significant loss of revenue for the General Fund.
Procurement
Not applicable.
Attachments:
1. Medicare Enrollment Application - CMS-855B
2. Medicare Electronic Data Interchange (EDI) Enrollment
3. Medicare EDI SPOT Enrollment
Prepared by: Deanna Marshall, Senior Business Manager, Fire Rescue
Department Director: Scott Titus, Fire Chief